Provider Demographics
NPI:1457629875
Name:THE ROGOSIN INSTITUTE, INC.
Entity Type:Organization
Organization Name:THE ROGOSIN INSTITUTE, INC.
Other - Org Name:IMMUNOGENICS AND TRANSPLANTATION LABORATORY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-746-1551
Mailing Address - Street 1:430 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4826
Mailing Address - Country:US
Mailing Address - Phone:212-772-6700
Mailing Address - Fax:212-861-9473
Practice Address - Street 1:430 E 71ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4826
Practice Address - Country:US
Practice Address - Phone:212-772-6700
Practice Address - Fax:212-861-9473
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE ROGOSIN INSTITUTE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-13
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3240291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33HL04Medicare Oscar/Certification